Читать книгу 52 Years Coping with Chronic Back Pain - Alvaro Graña - Страница 16

CAUSES OF JOINT PAIN

Joint pain can be caused by many types of injuries or conditions. The following are some of the most common ones:

– Unusual exertion – A strain or sprain the ligaments or muscles can result from a sudden movement, improper movement or through overuse. In the case of back pain, discs can be damaged in the same way, and they can tear or overstretch.

– Injury, including fracture

– Osteoarthritis is the most common form of Arthritis. This chronic disease causes the cartilage between the bone joints to wear away, leading to stiffness and pain. OA, as it is known, involves growth of bone spurs and degeneration of cartilage at a joint (common in adults over the age of 45).

– Septic arthritis, which is the inflammation to a joint caused by bacterial invasion.

– Tendonitis, which is the inflammation, irritation and swelling of a tendon which is the fibrous structure that connects muscle to bone.

– Bursitis, which is inflammation to the bursa that lies between a tendon and skin or between a tendon and bone. The bursae are fluid filled sacs that cushion and pad bones allowing muscles and ligaments to move freely.

– Gout, which is specially found in the big toe.

– Infectious diseases can include the following:

– Influenza

– Measles

– Rheumatic fever

– Hepatitis

– Mumps

– Rubella (German Measles)

– Varicela (Chicken Pox)

– Osteomyelitis

– Auto immune diseases, such as rheumatoid arthritis and lupus.

Arthritis

Arthritis is inflammation of one or more joints, which results in pain, swelling and limited movement. Arthritis involves the breakdown of the cartilage which normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on a joint while walking, running or jumping. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation) and stiffness.

Osteoarthritis

This type of arthritis is usually caused by a mechanical failure in the joint, with changes occurring in the articulate cartilage and bone. OA is a degenerative disease which most commonly affects the hip, knee, spine and finger joints. There are three main causes of osteoarthritis:

1. wear and tear as a result of the ageing process

2. as a result of an injury or surgical intervention

3. abnormal weight bearing placed on joints (especially hips and knees) over a considerable period of time or as a result of long-term obesity.

Rheumatoid Arthritis

This type of arthritis is caused mainly by chronic inflammation in the synovial linings of joints, tendon sheaths and bursae (sacs of fibrous tissues containing synovial fluid). The synovial lining coats the inside of the joint structure and produces fluid to help lubricate joint movement.

Ankylosing Spondylitis

Spondylitis means inflammation in the joints linking the vertebrae in the spinal cord. In ankylosing spondylitis the acute inflammation has receded leaving toughened damaged joints that have become fused together causing pain and restricted movement of the spine.

Joint Inflammation

Causes of joint inflammation include:

– broken bones

– infection (usually caused by bacteria or viruses)

– an auto immune disease

– general wear and tear on joints. Most of the time inflammation resolves after an injury has healed, although in some cases, the inflammation persists, becoming long-term (chronic) and deformity occurs. This is refered to as chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as part of the aging process.

Symptoms

May include:

– Joint pain

– Joint swelling

– Stiffness, especially in the morning

– Sensation of warmth around the joint

– Redness of the skin around the joint

– Reduced ability to move the joint.

Personal experience - The Alternative Medicine Specialist recommended me to take glucosamine sulphate and evening primrose oil together. She told me three important steps I needed to take:

1. She said according to research the dose recommended for me is 1500 mgs of each, daily.

2. Allow a long period of time before expecting the full effect (2 to 3 months maybe).

3. I had to carry on taking my prescribed medication and slowly reducing it over at least 2 or 3 months until I could stop it altogether.

This is what I did, under medical supervision, and it worked. When I say it worked, I mean that although not all the pains disappeared, I managed to not depend on prescribed medication, consequently avoiding all the side effects. This process took approximately 6 to 8 months. After a year I went to see the Alternative Medicine Specialist again and she said that according to new research in America and Canada, they found out that the normal dose mentioned above, when doubled, was even more effective. It was safe to increase the dose because they are all natural ingredients rather than drugs, and I had not shown any adverse reaction. People who are going to try this need to consult their doctor and make sure you are not allergic to shell fish (in the case of glucosamine sulphate) or any other component.

I increased both the evening primrose oil and the glucosamine sulphate to 3000mgs a day. It took a few months before I started to feel the benefits. My arthritic type pains in my knees, ankles, elbows and hands were almost gone (2006-07). Remember I said, I used to wake up every morning with terrible joint pains and found getting up a struggle? I don’t any more. Even the pain to my elbow is gone. This might be to do with the fact that I am a musician, and play quite a few string instruments. It is now about 14 years since I had serious pains in the mornings which made it difficult to get out of bed. The other recommendations that I received from the specialist was to do exercises guided by a physiotherapist, and eat a healthy diet. More on these last two points and complementary medicine later.

Treatment

Not all cases are curable.

Some recommendations:

– making lifestyle changes

– Pacing yourself – although it is good to keep busy and active, pacing yourself should be part of the new lifestyle. Only you know how much you can do and still feel positive (see more below).

– Exercise to maintain healthy joints, relieve stiffness, reduce pain and fatigue, improve muscle tone and bone strength. Exercise programmes need to be designed by a professional as an individualised programme according to each condition.

– Cold and heat treatment as needed – bearing in mind that muscles need heat, while nerve inflammation needs cold. Try both and see what works as it is sometimes difficult to pinpoint the origin of pain.

– Rest and exercise are both important, again try both and see what helps. It is sometimes helpful to take naps or lie down during the day, to recover from a flare-up more quickly. If you need a longer rest, bear in mind that this is temporary. To stay positive think and plan what you will be doing next.

– Avoid positions or movements that place extra stress on your affected joints.

– Avoid holding one position for too long.

– Reduce stress, avoid worrying about things and tensing up, or stress from work as these can aggravate symptoms. Try to relax by using meditation, guided imagery, yoga or Tai Chi, on these last two consult your doctor.

– Modify your home if it is going to make your life easier.

– Taking glucosamine sulphate and evening primrose oil in combination (always consult your doctor first) – They don’t work for everybody with joint or back pain, but they are worth a try.

– Healthy eating – Eat sensibly and avoid becoming overweight to minimise the pressure on your joints. Take calcium to keep your bones strong (around 700 to 1000mg a day) by eating dairy products, small boned fish, fortified bread and cereals, or calcium supplements (always consult your doctor first). Eat a diet rich in vitamins and minerals, especially antioxidants like vitamin E. These are found in fruit and vegetables. Brewer’s yeast, wheat germ, garlic, whole grains, sunflower seeds, and brazil nuts contain selenium. Omega-3, which is shown in studies to reduce inflammation in arthritis and slow the process of joint damage, can be found in fatty acids from cold water fish, (like salmon, mackerel and herring), flaxseed, rapeseed oil, soybeans, soybean oil, pumpkin seeds and walnuts. Therefore the key to keeping healthy joints is regular exercise (see section EXERCISE – page 58) and a healthy diet (see GENERAL HEALTH – page 100).

Personal experience - After my consultation with the Complementary Medicine Specialist at Walsgrave University Hospital I went to see a physiotherapist. I was determined to give exercising on a regular basis a good go. I remember being advised to do this before my operation, but didn’t follow it seriously. I did this time. The idea was to strengthen all the muscles around my waist by doing abdominal and lower back exercises; plus stretching and contraction exercises for my legs and body in general. I later added exercises for my neck, which had been one of my weak points for a long time.

My physiotherapist was very supportive and encouraged me to take exercising seriously and consistently. I still remember what she said “As you brush your teeth everyday, you should do your exercises every day too,” adding that “It will take a bit of time before you see any progress.” I followed her advice persevering with the physio exercises and later down the line I was able to see the difference. I still do them today (December 2020). The specialist worked on my physical fitness as well as on my mental attititude by recommending and teaching me the different exercises I need to do every morning before getting up. She advised me to start doing only 5 repeats of each exercise; and very slowly increase the number over a period of time. After four years of slowly increasing the number of some of my exercises, now I do 100 of each as well as my lower back muscle exercises, and 500 abdominal exercises (which I do lying on my back, knees up. I do them in bed before I get up). More on these exercises and how they should be done later. I feel fit and strong now in those areas of my body. Again I am not saying that all my pains have disappeared but I am a lot stronger and my body can cope with pain better. After four or five years following the daily exercise programme I no longer get the regular severe pains on my lower back. When I do ocasionally experience pain, my recovery time is quicker and better. I no longer get any of the strong abdominal pains nor the nausea (I used to feel so sick sometimes that I used to vomit due to the pain). I still had severe pains to my neck and head (similar to severe migraine attacks) occasionally, but today (2020) I hardly get migrains. When I get migrains I use the hot and cold treatment, by putting hot and cold around my neck and shoulders at bed time. I do a bit of relaxation (see relaxation techniques below), which helps me to go to sleep. In 2018 I started having pains in my neck (this time it was different, not migrains) and went to see a physio who recommended exercises for my neck, and now (2020) I am free of pain.

What is most important to acknowledge here is that various different treatments and/or actions can be used to help deal with chronic pain. In fact I would advise everybody to try different methods, without taking any risks, and use those which you find will help in the long run. That is certainly my approach, at present I am using various different treatments and actions simultaneously, and they all help a little. Obviously you are going to use treatments, such as heat and cold packs when in pain at different times alongside regular exercise, a warm wheat bag at bedtime, and a healthy diet. The combination of exercises and the previously mentioned glucosamine sulphate and evening primrose oil are the perfect combination for me. You can oil your joints as you would a squeeky door!

By 2006-07 I had stopped having arthritic type pains.

Another problem I had years ago was pain on my heels when I walked. If I walked 10 or 15 minutes barefoot around the house I would end up with pains on my back and heels. I tried various cushion heel pads which helped a little, then found using two cushion pads in each shoe felt better.

Later, I realised gel cushion pads were the best. I tried layering them...; by 2015 I was using 4 layers of gel cushion heel pads, 2 – 2.5cms. high. The disadvantage is that I can’t wear moccasins or sandals any more, but I prefer to minimise my pains.